Basic Information
| Provider Information | |||||||||
| NPI: | 1659745917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACHUO | ||||||||
| FirstName: | TERENCE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3345 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772533345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137969955 | ||||||||
| FaxNumber: | 7137969779 | ||||||||
| Practice Location | |||||||||
| Address1: | 2626 S LOOP W STE 265 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770545636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137969955 | ||||||||
| FaxNumber: | 7137969779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2015 | ||||||||
| LastUpdateDate: | 06/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP129584 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 368742805 | 05 | TX | MEDICAID |